Provider Demographics
NPI:1467280958
Name:PEMBER, JESSICA (RN, BSN, APRN, CNM)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:PEMBER
Suffix:
Gender:F
Credentials:RN, BSN, APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 KINGSLEY AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-9200
Mailing Address - Country:US
Mailing Address - Phone:904-264-1628
Mailing Address - Fax:
Practice Address - Street 1:1560 KINGSLEY AVE STE 4
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-9200
Practice Address - Country:US
Practice Address - Phone:904-264-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9534455163WM0102X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn